Kings and Queens of Carb Counting Share their Secrets

The results are in. Apparently, there is universal interest in the topic, because we received hundreds of entries in our carb counting contest from people as far away as Eastern Europe and Australia. We all think we’re “experts” after years of label reading and WAG counting, but our three winners really showed their expertise and scored high in all three sections of our Integrated Diabetes Carb quiz.

I sat down with each of them (well, I sat in my comfy chair and hopefully they sat in their comfy chair at home too!) to learn their story. They shared a bit about diagnosis, products they use and where they received education. Most importantly, they shared what they feel are the most important tools they use to carb count with such accuracy. Read on and pick up some more useful tips for your diabetes tool-box!

Stephanie: Lives in New York when at school and is currently enjoying time in Boston for a work internship. Stephanie is on the lacrosse team at Vassar College, and also enjoys running. Five miles is her longest distance at present, but, she would like to do a ½ marathon at some point. She aims for a BG target of 130-150 when going out for practice or a run. She finds she has to adjust a bit differently when going out on a run compared to lacrosse, and compensates before a run with a 15g carb snack and uses a temp basal to prevent a drop.

Lisa: Lives in Alberta, Canada. She was diagnosed within days of her daughter’s diagnosis. She was in the hospital at her daughter’s discharge classes and did a finger-stick and her BG came up as 28 mmol/dl (500 mg/dl). The nurse had her redo the finger-stick which was also elevated and they admitted her to the hospital at that point. Her daughter was discharged, but she stayed in the hospital for 5 days. She feels she learned a lot in the classes that she attended with her daughter right before her diagnosis.

Stephen: Lives in Houston, TX. Initially diagnosed with type 2 in 2009 (due to his weight gain and unhealthy habits), and re-diagnosed in May 2014 with type 1. He started on 70/30 insulin but experienced a very low BG and was taken off of insulin. He was switched to Metformin with some initial success, but then noticed his BG values started creeping up again and assumed if he got back to healthy habits that BG would respond. In January 2014 he decided to start working out with a fitness plan to try to “get rid of” his diabetes. When he lost weight (70 lbs) and his BGs didn’t respond, he started to reinvestigate his diagnosis. In May 2014 he started working with an Endocrinologist who did some testing to evaluate for type 1 and he found out he was misdiagnosed.

How old were you when you were diagnosed?

Stephanie: I have had type 1 diabetes for 11 years. I was diagnosed 3 days before my 10th birthday – I was in the hospital for 3 days and then I had a big birthday party the following weekend with all the normal birthday fare – birthday cake, ice cream, etc!

Lisa: I have had type 1 diabetes for 9 years. I was 35 when I was diagnosed, and my daughter was 9 years old. We have no other family members with type 1.

Stephen: I was diagnosed 5 years ago, but just the past 3 months I’ve had an official diagnosis of type 1.

How do you take insulin?

S: I use a pump – Medtronic, for 9 years (I started on Animas and switched to Medtronic a few years ago. I plan to switch back to Animas once the VIBE is available here in the US)

L: – I’ve used Animas for about 2 years. I had to wait to get mine approved and covered by insurance.

Stephen: I do not use a pump at present. I can see moving towards use of this technology in the future, but right now I use Levemir (dosed 2 x/day) and the Novolog Echo pen to be able to dose in ½ unit increments.

Do you use a CGM?

S: I use a Dexcom G4– I just started with CGM a few months ago. I feel it’s most beneficial in overnight control as well as following a meal. The CGM has helped me learn about the effect of my typical foods. I have also learned the benefit of pre-bolusing before my meals. It really gives me better post meal control (she now boluses about 20 min before the meal).

L: I’m not using a CGM. Most doctors here don’t push for this product (They typically want 90% of pediatric patients on a pump, however, adults have to be proactive and ask for products).

Stephen: Using my Dexcom G4 CGM has been a game changer for me.Being able to follow the trend really helps me make the best decisions. It helps me to trust my dosing and my carb counting. Without this I was doing 16 finger sticks/day and sometimes doubling up on insulin with subsequent low BG from stacking my insulin.

What kind of education did you receive?

S: I had good education in the hospital. It felt like a crash course because I wasn’t there very long and it was a lot of information over a short time span. My Doctor required me to go to a training course before I could start using my insulin pump to ensure I learned to accurately count carbs and understand portions and label reading. I think this is where I really started to notice the benefit of accuracy with dosing precisely with a pump.

L: I feel my education in the hospital was mostly through the pediatric training classes I did while my daughter was in the hospital. The hospital provides a vast amount of information for pediatric patients – 5 days for my daughter. Since I was in the hospital for diagnosis too, I compared what I received to what my daughter received and I only had 1 day of focus on meal planning and carb counting. It was nowhere near as intense. Adults with diabetes (type 1 and type 2) have to advocate for education for their self. After a while, I switched to Adult intensive training – this provided the additional education I wanted and includes a good support from nurse educators who are all trained on pump use.

Stephen: When I was first diagnosed I didn’t have any formal education. I did a lot of my own research and reading – mostly self-education. Then I started to work with the team at Integrated Diabetes Services by phone and e-mail. That’s where I really did the most learning.

What are some of the tools you’ve used over the years to count carbs?

S: I’m using measuring cups and a food scale at home to be as accurate as possible. At times I am tempted to just pour a cup of milk without using a measuring cup, but then I think about how well controlled my BG is because I do measure and this helps me continue to use tools.

L: I started by using measuring cups and a food scale. After a few years I learned about “carb factors” and this has been most helpful for more precise counting for the portions I want to eat. I use carb factors a lot for fruits and vegetables. I find when I use measuring tools at home it trains my eye to be aware of what a particular portion looks like and how much carb it may contain – it’s so helpful when I don’t have a label to read. When I’m eating out at a restaurant I look up information online or I use my Calorie King book as a reference.

Stephen: There was a learning curve –some foods don’t “look” like they would have sugar! I had to remember there was carb in milk! I downloaded Gary’s book – Think Like a Pancreas and read it in one night and realized I needed help. I use Calorie King and I look up glycemic index as well as information when I’m going to go out to eat. I do use measuring cups and labels, as well as the estimation tricks I’ve learned from working with Integrated Diabetes Services. I’m the primary cook at home so it’s easier to count when you know what has gone into a dish you’ve prepared.

What has worked the best for you to ensure accuracy?

S: Measuring is my best tool. I feel measuring at home has helped me count carbs more accurately when I don’t have a label or the measuring tools to use – such as in the College dining hall. I have learned to eyeball a portion of carb when eating out by weighing fruits and other carbs at home. I also tend to look info up before going out so I have a more specific count than a simple guess, especially if it is a restaurant that I’ve never been to before.

L: I use eyeball portions when I have to “guess”. I often refer to the size of a tennis ball because I know about how much this is as a measured portion and then I can more accurately account for the carbs when I have to guess. My best time saving trick at home is to use a measured ladle for soups/casseroles (½ cup per ladle), and I use drinking glasses with a line that equates to a specific portion (pouring up to this line on the glass is equal to 1 cup).

Stephen: I feel the best trick is to trust my gut feeling. Calorie King may say “this is 15g carb”, but then I’ll consider my past experience with the food and what the response was on my CGM. I may adjust up or down by 2-5g based on previous experience. The use of measuring cups and labels are also major players in ensuring I learn how to count – it helps when I have to guess something that may not have a label.

Do you take into account fiber/glycemic index/glycemic load?

S: I do consider fiber – I subtract it all off the carb count. If it is a lower glycemic index food, I may deduct a bit off the suggested bolus.

L: I don’t use anything scientific, but I keep these things in mind when meal planning and counting carbs to evaluate the effect after meals.

Stephen: I do consider fiber – I subtract all of it off of the carb count. But, I also take into account the kind of food it is or the glycemic index of the food– sometimes I only subtract ½ the fiber count (I use this for things like granola bars because of all the added sugar, I’ve found that I really can’t subtract all the fiber noted).

Do you feel the use of “smart” pump features helps you cover your meals better?

S: I haven’t been using square/dual bolus (no one has really taught me what to use them for) – but I do use the temporary basal feature for my Lacrosse practice as well as running. I feel it’s the accuracy in counting carbs that makes the major difference in post meal control.

L: I like to use these when grazing or when eating out at a buffet – I don’t think I use this often enough and when I look back at my pump records, I see I could probably use it for more foods/meals. It’s a question I should ask my nurse educator about so I can use this more effectively. Since I do a good job with precise carb counting already, I assume proper use of the combo bolus would improve my BGs even more!

Stephen: I have no experience with the smart features on the pump, but I would assume that it’s accuracy in counting as well as portion estimation that makes the most difference.

Do you have any words of wisdom to help everyone become a king or queen of carb counting?

S: “When you are home and you have access to scales/measuring cups – use them frequently. This will help you with more precise guess-timation when you are out and don’t have your tools or a label available.”

L: “Take classes or ask to take them. You might think you are good at counting carbs and there isn’t anything new you’ll learn, but there is always something new. Every class seems to teach me something I didn’t know before, even as good as I think I am at counting!”

Stephen: “Measure your portions when you have the tools available, and learn how to estimate these when you are away from your measuring tools.”

Regarding glycemic index, I do not use this at all. The reason is that there are too many variables to make it a useful tool. For example, the ripeness of the fruit affects GI. If I prepare rice, which is high GI but then put margarine on it, I just slowed down the rate of absorption negating the GI information. A slice of bread – high GI – with peanut butter, again makes GI unhelpful.